Syndromic testing with the FilmArray® meningitis/encephalitis (ME) panel (BioFire Diagnostics, bioMérieux) in children with central nervous system (CNS) infection was found to significantly reduce the duration of antibacterial and antiviral use, length of hospital stay, and total cost of hospitalization, according to study results published in the European Journal of Clinical Microbiology & Infectious Diseases.
Approved by the United States Food and Drug Administration in 2015, the FilmArray ME panel uses multiplex polymerase chain reaction (PCR) to detect 14 pathogens (7 viral, 6 bacterial, and 1 fungal) that are most commonly involved in CNS infections in about an hour with minimal hands-on time.
In this prospective cohort study, researchers at a tertiary pediatric hospital in Athens, Greece aimed to evaluate the possible benefits of FilmArray ME panel in a pediatric population. Children who had a clinical diagnosis of CNS infection, without underlying or chronic diseases, and with a cutoff of cerebrospinal fluid (CSF) pleocytosis > 15 cells/mm3, were included in the study. Conventional microbiological procedures ─ including CSF analysis (cells, protein, glucose), bacterial culture, and gram stain ─ were performed in all children. In order to assess the benefits of FilmArray ME panel, children were randomly assigned in a 1:1 ratio for further CSF molecular testing either with the FilmArray ME panel (case group) or with single PCRs for bacteria and/or viruses (control group).
Of the 142 children included in the study (71 in the case group and 71 in the control group), 82 were boys and 82 were <3 months old. There were no statistically significant differences between the case group and control group regarding age, including baseline blood and CSF laboratory findings for children <3 months old vs children >3 months old.
A pathogen was detected in 52.1% of children in the case group and in 22.5% of children in the control group (P <.001); the difference remained significant in infants <3 months old as well as in older children. There was a higher detection rate with FilmArray ME panel for bacteria and viruses. Aseptic meningitis was detected in 44.2% of children in the case group and in 16.7% (11/66) of children in the control group (P <.001).
Compared with the control group, the median length of hospital stay was shorter in the case group (5 days vs 8 days [interquartile range (IQR) 4-8 days vs 6-10 days]; P <.001). Likewise, those in the case group had a reduced duration of antibacterial use (4 days vs 7 days [IQR 2-5.7 days vs 5-10 days]; P <.001) and antiviral use (3 days vs 5 days [IQR 2-4.75 days vs 3-9.25 days] for acyclovir; P <.001). In addition, the median hospitalization cost was less in the case group vs control group (1042€ vs 1522€ [IQR 932€-1372€ vs 1302€-1742€]; P <.001).
Although the most frequent neonatal bacterial pathogens are included in the FilmArray ME panel, there are others such as Citrobacter, Klebsiella, Mycobacterium tuberculosis, or other Escherichia coli types that are not contained within the panel. Thus, clinical judgment should guide treatment modifications based on the evaluation of the patient. “Custom-made panels depending on the area or the addition of more emerging pathogens to the existing panels would be appealing options for future improvements,” stated the researchers.
In addition, researchers noted that the “economic evaluation was conservative, as costs for antibacterial, antiviral medications, or supplementary laboratory exams for the additional hospitalization days were not included in the analysis.” More prospective studies are needed to discuss implementing antimicrobial stewardship strategies based on the results of the FilmArray ME panel, and also to assess the cost-effectiveness of the FilmArray ME panel, including in children with underlying or chronic diseases.
Lamprini Posnakoglou L, Siahanidou T, Syriopoulou V, Michos A. Impact of cerebrospinal fluid syndromic testing in the management of children with suspected central nervous system infection [published online July 18, 2020]. Eur J Clin Microbiol Infect Dis. doi:10.1007/s10096-020-03986-6